Magnitude of Resistant Hypertension and Impact of Aldosterone to Renin Ratio In Resistant Hypertension

摘要

Background: Resistant hypertension is a common clinical problem faced by both primary care clinicians and specialist. The magnitude of resistant hypertension is highly variable and is reported to be in the range of 12.8% to 25%. Increased incidences of elevated aldosterone levels have been implicated in difficult to manage hypertension. Aim: To estimate the magnitude and identifiable causes of resistant hypertension among on therapy hypertensive patients, and also to compare the aldosterone levels and aldoster one ren in ratio between resistant and controlled hypertensive conditions. Subjects and Methods: This Multistage, exploratory comparative study was conducted at JSS Hospital and Research Centre, Mysore, India for two years. 1537 adult hypertensive on antihypertensive drugs for a minimum of six months were included. Those who were on three or more antihypertensive medication with blood pressure not under control were defined as having resistant hypertension. Results: Prevalence of resistant hypertension was 16.13% (n=248). There was a marginal difference in the prevalence of resistant hypertension in male (51.2%, n=127) and females (48.8%, n=121). Renal diseases were the most common cause of resistant hypertension (n=103). Aldosterone Rennin Ratio >20 was significantly higher in resistant hypertensives without evident secondary cause compared to hypertensive’s who were well controlled with less than three antihypertensive. Conclusion: Frequency of hyperal dosteronism with high ARR (Aldosterone to Renin Ratio) among resistant hypertensive’s with no evident secondary cause for hypertension, probably suggestive of Primary hyperal dosteronism. This makes us to consider estimation of ARR in resistant hypertensive and also consider use of aldosterone antagonists as primary option for good control of Hypertension.